Peripheral Blood Smear Examination Research Articles

Haemosporidia of grey crowned cranes in Rwanda.

Grey crowned cranes (Balearica regulorum) have been facing significant and long-term population declines in East Africa. Studies of Haemosporidian infections are essential to gain insight into pathogenic threats and help infer vector-host relationships, resolve parasite relationships, and support conservation efforts. As part of a program to reintroduce captive cranes in Rwanda back to their natural habitats, through health checks and initial microscopic examination, 120 grey crowned cranes were selected under suspicion of harboring Haemosporidian infections following initial peripheral blood smear examinations. Of these, 104 were infected with Haemoproteus and 3 were coinfected with Leucocytozoon as detected by PCR and microscopy. Sequencing allowed us to identify 2 distinct unreported lineages of Haemoproteus antigonis and one lineage of Leucocytozoon in the subspecies of Grey Crowned Cranes endemic to East Africa, B. r. gibbericeps. Molecularly, our two lineages of Haemoproteus antigonis differ by 32 base pairs and matched with about 95 percent identity to previously reported sequences of H. antigonis found in other species of cranes. No visible morphologic differences were found when compared to images of H. antigonis from previous studies. Our work demonstrates not only a need for increased testing within the family Gruidae, but also to investigate the possibility of cryptic speciation within the morphospecies Haemoproteus antigonis.

Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report

Background: Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is an enzyme abnormality related to sex chromosomes (x-linked), which is inherited. The activity or stability of the G6PD enzyme decreases, thus causing the breakdown of red blood cells when an individual is exposed to exogenous substances that can cause oxidative damage. This case study aims to describe a rare case of hemolytic anemia caused by glucose 6 phosphate dehydrogenase deficiency in a two-year-old boy. Case Presentation: A two-year-old boy presented with agitated, pale, yellowish eyes and body and projectile vomiting after consuming fava beans. He had a prior history of packed red cell transfusion. Physical examination found the conjunctivae were pale with the icteric sclera. Laboratory examination revealed leukocytosis, moderate normochromic normocytic anemia, increased reticulocytes count, and elevated total and unconjugated bilirubin. Peripheral blood smear examination found microcytes, spherocytes, fragmentocytes, and burr cells. Coomb test was negative with decreased G6PD result. Conclusion: G6PD deficient patients have no symptoms until exposed to oxidizing drugs, infections or after fava beans ingestion which may cause hemolytic anemia and jaundice. Several methods of screening and diagnosis of G6PD can be performed to avoid morbidity and mortality.

Jaundice in a Preterm Infant Twelve Hours After Birth.

Jaundice in a Preterm Infant Twelve Hours After Birth.

Immunophenotypic challenges in diagnosis of CD79a negativity in a patient with\xa0B acute lymphoblastic leukemia harboring intrachromosomal amplification of chromosome 21: a case report

BackgroundBeing expressed in all stages of B-cell development and having a significant value on the European Group for the Immunological Characterization of Acute Leukemias scoring system, CD79a is considered as an excellent pan-marker for lineage assignment of B cells by flow cytometry. Therefore, any lack or decrease in CD79a expression makes the diagnosis of B acute lymphoblastic leukemia cases very challenging, especially in developing country laboratories where flow cytometry analyses are not always available and, when they are, they are limited in the number of markers used for lineage assignment. Since this case is potentially interesting, we report a B acute lymphoblastic leukemia case with a lack of expression CD79a associated with intrachromosomal amplification of chromosome 21 genetic abnormality. We further discuss the practical challenges in the diagnosis of this case.Case presentationWe present the case of an 8-year-old Caucasian boy from eastern Morocco who was initially hospitalized for a hemorrhagic syndrome. Peripheral blood smear examination showed a significant number of blasts suggesting acute leukemia. Bone marrow was studied for morphology, cytochemistry, immunophenotyping, and cytogenetics. Flow cytometry analyses showed expression of CD19, CD22, CD10, CD34, and HLA-DR markers by leukemic blasts. The expression of CD79a, which was checked with two different monoclonal antibodies, confirms that this marker was severely decreased in this case. Cytogenetic study performed by fluorescence in situ hybridization revealed the presence of intrachromosomal amplification of chromosome 21, a cytogenetic abnormality that is specific for B acute lymphoblastic leukemia.ConclusionCD79a is one of the critical markers in the assignment of B acute lymphoblastic leukemia. In our case, we were lucky enough to be assisted by a few other markers of the B lineage that were positive in this case. Also, we mention the importance of proceeding to cytogenetic study, which in our case helped us to confirm the diagnosis made by flow cytometry by highlighting a cytogenetic abnormality that is specific to B acute lymphoblastic leukemia.

The Brief Case: A 6-Year-Old with Fever, Abdominal Pain, and Recent Travel to Sierra Leone.

A 6-year-old girl presented to the Nationwide Children’s Hospital emergency department in Columbus, OH, following a 3-day history of fever and 1 day of abdominal pain. She had recently returned from a 2-week trip to Sierra Leone and did not undergo any antimalarial prophylaxis. In the emergency department, she was found to be hypotensive and febrile and had altered mental status. Her maximum temperature from the day of admission was 40.1°C. She was started on broad-spectrum antibiotics, and laboratory testing was performed. Her initial laboratory results demonstrated a low hemoglobin of 8.9 g/liter, which dropped to 6.0 g/liter within 3 h (normal range, 11.5 to 15.5 g/liter), a total bilirubin elevated to 6.6 mg/dl (normal range, 0.1 to 1.0 mg/dl), and lactate dehydrogenase of 1,582 U/liter (normal range, 350 to 850 U/liter). These symptoms and lab findings prompted the clinical team to order a malaria evaluation, including thick and thin blood smears and an immunochromatographic malaria rapid diagnostic test (BinaxNOW Malaria; Abbott Laboratories, Abbott Park, IL). This assay detects the histidine-rich protein 2 (HRP2) antigen specific for Plasmodium falciparum on line T1, as well as a pan-malarial aldolase on line T2, which is expressed in all of the malaria species that infect humans: P. falciparum, P. vivax, P. ovale, and P. malariae (1). The screen for this patient generated T2 and control bands, indicating infection with P. vivax, P. ovale, or P. malariae (Fig. 1A). However, examination of peripheral blood smear showed morphologic findings consistent with P. falciparum species (frequent ring forms with more than one chromatin dot, multiple ring forms infecting the same red cell, and infected red cell size similar to noninfected red cells). Parasitemia was high, with more than 20% of red cells infected (Fig. 1B).

A discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Blood group discrepancy is a discrepancy in the results of the cell grouping with serum grouping examination. The source of discrepancy is from technical errors or a patient's medical status such as age, disease, history of blood transfusion and medication, pregnancy. This case study aims to evaluate a discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, IndonesiaCase Presentation: A male baby, 6 months 19 days old, was unable to defecate since birth post-colostomy. Physical examination reveals anemia. A routine blood test showed a hemoglobin level of 8.8 g/dL. The diagnosis was high position anorectal malformation post colostomy suspect Hirschsprung Disease, with 110 cc Packed Red Cell (PRC) transfusion plan. A routine pre-transfusion procedure was performed. It was found a discrepancy of blood group A with missing antigen. Crossmatching with blood groups O and A both gave compatible results. Examination of peripheral blood smear after PRC blood group A transfusion found no signs of hemolytic.Conclusion: Blood group discrepancy, in this case, was due to missing antigen, which was caused by the possibility of gastrointestinal bacterial infection.

English

BACKGROUND This is a clinic-haematological study, conducted in Sidhanta Hospital, Bhopal, to identify the causes of pancytopenia. Out of total 1200 cases of complete hemograms, 56 cases were categorized as pancytopenias, and out of these, 24 cases were subjected to bone marrow examination. The remaining 32 cases of pancytopenia, were put on periodic follow up with peripheral blood smear examination, based on clinical data. Pancytopenia is the simultaneous presence of anaemia, leucopenia and thrombocytopenia that may result from various disease processes, involving the bone marrow primarily or secondarily. Pancytopenia is reduction in all the three cellular components of the blood, namely red blood cells (RBCs), leucocytes (WBCs) and platelets. It is a common entity which is encountered by practitioners. The presentation is in the form of cytopenias leading to infections, anaemia, or bleeding manifestations. All the cases of pancytopenia need a through approach to reach to the cause of the same so that it can be managed in the best possible manner. Cytopenias are reduction in any of the three cellular components of the blood i.e. RBCs, WBCs or platelets. It can be reduction in two cellular components (bicytopenia) or a reduction in all the three cellular components (pancytopenia). In bicytopenia, the most common combination to be seen is anaemia and thrombocytopenia, whereas the least common is leucopenia with thrombocytopenia. (1) For practical purposes, it should have haemoglobin < 10 g%, absolute neutrophil count < 1,500/cumm and platelets < 1,00,000/cumm. It is labelled as severe when the three values are < 7 g%, < 500/cumm and < 20,000/cumm respectively. The purpose of this study was to find out different causes of pancytopenia and the use of bone marrow examination in evaluation of pancytopenia. METHODS This is a cross sectional study, conducted exclusively in the Department of Medicine, at a tertiary care hospital, in Bhopal from August 2019 to December 2019. A total of 56 cases of pancytopenia were analysed with clinico-haematological features. Criteria for diagnosis of pancytopenia were: Haemoglobin less than 10 gm/dl, TLC less than 4000/mm3 and platelet count less than 1,00,000/mm3. We have correlated the complete hemogram findings with bone marrow examination (if required) and peripheral smear examination in order to analyse the root cause of every case of pancytopenia. Pancytopenia is a haematological entity, we have to analyse the cause of it in order to find out the correct diagnosis and treat the patient accordingly. Bone marrow examination is useful in the investigation of PUO (pyrexia of unknown origin), as it leads to an etiological diagnosis in many of the cases. RESULTS In these 56 cases, only 24 cases (42.85 %) were subjected for bone marrow examination. Commonest cause of pancytopenia was episode of viral fever constituting 28 cases (50 %). CONCLUSIONS In cases of PUO, bone marrow examination is a very useful investigation. In cases diagnosed as idiopathic thrombocytopenic purpura (ITP), when the patient does not show improvement in counts, a repeat bone marrow examination should be done, as very rarely; acquired amegakaryocytic thrombocytopenia may be the cause. Though bone marrow examination is an absolute indication in cases of pancytopenia, it is important to wait for at least 2 – 3 weeks, and do a repeat hemogram, especially in cases of viral fever where the counts usually improve after fever subsides. KEY WORDS Pancytopenia, Bone Marrow, Viral Fever

Comparison of peripheral blood smear examination with automated haematology analyzer for diagnosing different types of anemia.

Objective: This study aims to determine diagnostic accuracy of peripheral blood smear and automated haematology analyzer and to determine frequency of different types of anemia diagnosed by peripheral blood smear and automated hematology analyzer. Study Design: Cross Sectional study. Setting: Department of Pathology, Rawal Institute of Health Sciences, Islamabad. Period: November 2015 to April 2016. Material & Methods: Sample size of 149 suspected anemia patients was calculated using WHO calculator with 95% confidence interval. Research approval was taken from hospital ethical board. Patients were approached through non probability consecutive sampling method. Both peripheral blood smear examination and automated haematology analysis of each sample was performed. Diagnostic accuracy and frequency of anemia types was measured. Data analysis was done with the help of SPSS version 25. Chi-square and fissure exact test and ROC curve analysis was applied and significant (p<0.05) results were reported. Results: Total 149 patients were included in study. There were 42(28.2%) male and 107(71.8%) female. Mean age of patients was 35.1±2.1SD. Peripheral blood smear and automated haematology analyzer showed sensitivity (68% vs 92%), specificity (59% vs 88%), PPV (72% vs 92%), NPV (55% vs 88%) and diagnostic accuracy (64% vs 91) respectively. Most common type of anemia diagnosed with peripheral blood smear was microcytic hypochromic anemia with raised RDW 36.7% followed by normocytic normochromic anemia with raised RDW 13.3% and macrocytic anemia (p=0.001) while in automated haematology analyzer microc ytic hypochromic anemia with raised RDW54.4% followed by normochromic normocytic anemoia with normal RDW 11.1% (p=0.000). Conclusion: Automated haematyology analyzer had high diagnostic accuracy for diagnosis of anemia. Microcytic hypochromic anemia and normocytic normochromic are most common anemias diagnosed by peripheral blood smear and automated hematology analyzer and peripheral blood smear cannot be completely replaced by automated haemolytic analyzer. However, if both methods are used simultaneously, more accurate results can be obtained.

Hematologic Presentations of COVID-19 Can be Misinterpreted as Acute Myeloid Leukemia

Introduction: COVID-19 infection prompts inflammatory responses and acute lung injury in human beings. Complete blood count with differential is essential investigative tool in its managing. However, very few studies revealed the variations of blood cell morphology in this disease.Case report: We reported a 39-years- old female patient complained of respiratory distress one week prior to hospitalization. The patient suffered from cough, fever, and molecular test was reported positive for COVID-19 infection. Laboratory data revealed severe permanent leukopenia and peripheral blood smear examination showed blastoid cells after remission of respiratory signs. Patient underwent bone marrow biopsy for rule out acute myeloid leukemia. But, on bone marrow sample, only viral cytopathic effects were seen. COVID-19 virus stimulates inflammatory cells to produces various inflammatory cytokines and as a result, viral cytopathic effects on white blood cells is seen. Conclusion: We have described how the characteristic peripheral blood findings of COVID‐19 infection can be misinterpret as acute myeloid leukemia.

English

BACKGROUND In the evaluation of patients with non-Hodgkin lymphoma (NHL), determination of bone marrow involvement is an integral part of staging work up. Peripheral blood counts and examination of blood smears are also done in patients with lymphoma as part of pre-treatment investigations. METHODS A cross sectional study of 78 patients with a prior histopathological diagnosis of NHL was conducted. Peripheral blood counts were performed on an automated haematology analyser to look for various cytopenias. Peripheral blood smears and bone marrow aspirate (BMA) / imprint smears were examined in detail for atypical lymphoid cells. Bone marrow trephine biopsies of these patients were studied to assess the NHL involvement and the various patterns of involvement. Adjuvant immunohistochemistry (IHC) was performed in bone marrow biopsies with scant cellularity or crush artefact to discern the marrow involvement. RESULTS Bone marrow trephine biopsy showed involvement by lymphoma in 65.4 % cases. The incidence of involvement was higher in B-cell lymphomas, especially in low grade types. The predominant pattern of involvement was interstitial pattern (41.2 %). Discordant histology between bone marrow and the primary anatomic site was found in 7.8 % of the cases, which was seen more in diffuse large B-cell lymphomas. Majority of the patients with bone marrow infiltration by NHL had anaemia (84.3 %). Bicytopenia and pancytopenia were also observed. On peripheral blood smear examination atypical lymphoid cells were present in 23 % cases. CONCLUSIONS Bone marrow examination is an important aspect in the diagnosis of NHL, because of its both prognostic and therapeutic implications. Hence, the presence of atypical lymphoid cells and other changes in the peripheral blood should be detected in these patients. KEYWORDS Non-Hodgkin Lymphoma, Bone Marrow Biopsy, Bone Marrow Aspirate / Imprint, Peripheral Blood Smear, Atypical Lymphoid Cells

A STUDY OF DISTRIBUTION OF LEUKEMIA CASES IN A TERTIARY CARE CENTRE

Introduction: Leukemias are neoplastic proliferations of hematopoietic cells. Its incidence is increasing slowly and steadily. Leukemias form a major proportion of haematopoietic neoplasms that are diagnosed worldwide. Objective: To nd out the incidence of four major types of leukemias in a tertiary care centre in central India. Methods: A total of 105 cases were selected over a period from July 2019 to June 2020. Diagnosis was based on peripheral blood smear examination. Results: Out of 105 cases , 13 cases (12.38 %) were of Acute Lymphoblastic Leukemias, 33 cases (31.42 %) were of Acute Myeloblastic Leukemias, 44 cases (41.90%) were of Chronic Myeloid Leukemias, 15 cases (14.2%) are of Chronic Lymphocytic Leukemia . Conclusion: The present study showed that Chronic leukemias were more common than acute leukemias with Chronic Myeloid Leukemia being the most common type, followed by acute myeloid leukemia, chronic lymphocytic leukemia and acute lymphoblastic leukemia

Odynophagia: A Rare Presenting Symptom in Acute Myeloid Leukemia (FAB AML - M2)

Acute myeloid leukemia is more common in adults than in children population. Fatigue, bleeding and fever are the most common presentations. Petechiae, gingival swelling, lymphadenopathy and hepatosplenomegaly are common signs. Here we report a case of a 57 years post-menopausal lady with gum swelling and pain on deglutition for both liquid and solid foods. She was diagnosed with a case of AML- M2 on the basis of peripheral blood smear and bone marrow examination findings.

Objectivity and Practice of Peripheral Blood Smear Examination for Childhood Anemia Diagnosis in Benghazi Children Hospital /Libya

Introduction: Anemia is a common disease in children. Peripheral Blood Smear (PBS) require effort and human resource. In this study, we will evaluate objectivity of PBS ordering practice in Benghazi Children Hospital/Libya. Method: A retrospective study of PBS reports of 318 child in 2015 was conducted. Data collected include cause of PBS request, along with other relevant demographic, clinical and laboratory details. Kappa statistic was used for analyzing degree of agreement of results between PBS and Complete Blood Count (CBC) in anemia diagnosis. Results: Our study showed that Hematologists and 88.7% by general pediatricians requested only 6.9% of PBS. Anemia was main cause of request in 36.2%. Only 33.7 % of OPD cases referred with suspect of anemia were revealed to be anemic upon PBS examination and 45.4 % referred with no suspect of anemia were revealed to be anemic upon examination in total study population, but not in Neonate. In 65.1%, there was an agreement between diagnosis of anemia by CBC and PBS. There was accordance of 76.6% between exclusion of anemia by CBC and PBS. Hypochromic microcytic anemia was diagnosed in 93 cases (29.2%), macrocytic anemia was diagnosed in 5%, and 65.7% were not anemic. Conclusions: PBS examination is none objectively ordered and over utilized by Pediatricians in outpatient settings and for routine practice with less yield. Establishing laboratory guidelines for improving utility of PBS, careful and complete justified requests, discussion with laboratory staff, and continuous auditing practice are noticeable needs in the Benghazi Children Hospital.

Antioxidant Status, and Blood Zinc and Copper Concentrations in Dogs with Uncomplicated Babesiosis due to Babesia Canis Infections.

IntroductionThe aim of the study was to demonstrate a link between uncomplicated Babesia canis infection in dogs and blood concentrations of zinc and copper and erythrocytic antioxidant defence – activities of glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT).Material and MethodsThe study was based on 15 naturally occurring cases of canine babesiosis with anorexia, pyrexia, depression, pale mucous membrane, splenomegaly and dark red urine. Microscopic examination of Giemsa-stained peripheral blood smears and the results of PCR confirmed B. canis infection. Seven apparently healthy dogs brought in for either a check-up or vaccination were used for comparison.ResultsThe levels of the erythrocytic antioxidant enzymes - SOD and CAT - were significantly higher in the infected dogs than in cytologically negative dogs. The levels of blood micronutrients were significantly lower in the infected dogs (0.478 μg of zinc per mL vs 1.241 μg/mL and 0.722 μg of copper per mL vs 1.392 μg/mL).ConclusionOxidative stress can be posited as one of the mechanisms leading to anaemia in dogs with babesiosis, and therefore antioxidant biomarker and copper and zinc concentrations could be used as indicators of disease severity and prognostic markers.

Does Malaria Co-Infection Alter the Clinical Course in Children Infected with Dengue? Analysis from 623 Indian Children Admitted with Dengue Infection.

Dengue and malaria co-infection has been reported in several case reports. We aim to study effect of malaria co-infection on clinical outcomes of dengue infection. Records of 623 children with dengue infection, based on NS-1 antigen and IgM ELISA testing, were collected. Malaria co-infection was identified in 20 cases, based on peripheral blood smear examination. Clinical and hematological parameters were compared in two groups (malaria co-infection vs. dengue mono-infection). Duration of hospitalization was significantly higher in co-infected group. Significantly higher proportion of malaria co-infection cases had hepatosplenomegaly, hemoglobin ≤8 g/dl, serum albumin ≤3 g/dl, serum bilirubin ≥1 mg/dl, serum aspartate aminotransferase ≥500 U/l and serum alanine aminotransferase ≥300 U/l. Number of transfusions (PRBC and platelets) required in malaria co-infection group was higher. Malaria co-infection in dengue impacts clinical presentation, hematological parameters, requirement of blood transfusion and morbidity. High index of suspicion is warranted while evaluating febrile patients.

SIGNIFICANCE OF THE EXPRESSION OF CD123 AND THEIR CLINICAL IMPACT IN ACUTE MYELOID LEUKEMIA AMONG SUDANESE PATIENTS

Background: Acute myeloid leukemia (AML) is a heterogeneous clonal disorder characterized by immature myeloid cell proliferation and bone marrow failure. This study was prospective study conducted in Khartoum state during period from October 2018 until 2021
 Objective: This study was aimed to determine the significance of the expression of CD123 in Sudanese Patients with Acute Myeloid Leukemia, and their clinical impact.
 Method: The study population was selected as 100 AML patients as study group. 2.5 ml of venous blood were collected and poured into ethylene di-amine tetra acidic acid (EDTA) for examination of peripheral Blood smears and complete blood count, aspirate and trephine biopsy of bone marrow were collected for smearing and staining and detected CD markers by using flow cytometry
 Results: The result showed that 57.6% of AML patients with positive CD123. The study was revealed insignificant difference in CD123 in correlated to age with p.value=0.509, and also insignificant difference in CD123 when correlated to gender male and female with p.value=0.705, and the result showed that CD123 expression was significant decreased in bone marrow sample compared to peripheral sample with p.value=0.019, also the finding showed that CD123 expression was strongest being in M3 subtype (56.8+36.8) with P-value (0.099).
 Conclusion: This study was concluded that 57.6% of AML patients were positive for CD123 and also reflect thatCD123 expression was strongest being in M3 subtype.
 Keyword: Acute Myeloid Leukemia, CD123 ,Sudan .

A clinico-pathological study of geriatric anemias.

IntroductionAnemia in the older age (e.g., >60 years) is a major health problem in India and many parts of the world since it signifies an underlying disease and is associated with poor clinical outcome like increased morbidity and affects health‐related quality of life. Since symptoms like fatigue or shortness of breath related to anemia could also be attributed to the aging process, anemia is often easily overlooked in the elderly.Aims and objectivesClinico‐hematological patterns and morphological types of anemia in older age (e.g. >60 years) are manifold, hence this study was undertaken to determine them and to know more about associated disorders.Materials and methodologyThe present study was conducted on a sample size of 1257 patients who were 60 years and above and clinically diagnosed as anemic. Routine haematological investigations including peripheral blood smear examination and complete hemogram were done. Special investigations like bone‐marrow examination and iron studies were done whenever required.ResultsMales (aged >60 years) were more affected than females (aged >60 years) and patients in the age group of 60–69 years were affected the most. The most common presenting symptom was generalized weakness. The most common morphological type was normocytic normochromic anemia, and chronic diseases were the commonest etiological factors.ConclusionIn spite of modern diagnostic advances, geriatric anemias still remain under‐reported and inadequately investigated, necessitating evaluation of even mild anemias. Prompt diagnosis and definite categorization helps in appropriate management of anemias.

Efficient Segmentation of Lymphoblast in Acute Lymphocytic Leukemia

Microscopic examination of peripheral blood smears and bone marrow is the preliminary step for the diagnosis of several life-threatening diseases. Acute lymphocytic leukemia (ALL) is the most common disease in children that also needs an early diagnosis for on-time treatment as it spreads rapidly in the blood and forms immature lymphocytes. This might cause death in some weeks if left untreated. Manual methods in clinical laboratory being applied for the diagnosis of these diseases are inefficient and expensive, and the results are less accurate. A computer-aided system is the need of the day in which the most important step is segmenting the region of interest in blood or bone marrow for the detection and cure of the diseases which is the most challenging task. This study aims to propose a simple threshold-based segmentation technique by processing the S component of the HSV color space to segment the lymphoblasts in the bone marrow images of ALL patients. The technique was applied to 230 RGB bone marrow images having all the three types of ALL, i.e., L1, L2, and L3 resulted in the overall accuracy of 96.8%.

Unusual manifestations of malaria in children

Background: Till recently, vivax malaria was being regarded as a “benign” disease. Falciparum malaria is known to be a serious illness with life threatening complications as cerebral malaria, jaundice, acute kidney injury, metabolic acidosis and bleeding diatheses. Recently, some other atypical presentations are also, being noted, which have hardly been discussed previously. The present report highlights the various unusual presentations of malaria in children.Methods: The study design was hospital based prospective observational study conducted over one year. Children between the ages of 1 month to 18 years admitted with a diagnosis of malaria confirmed by peripheral blood smear examination and/or rapid diagnostic test having unusual manifestations were studied. Patients with dengue fever, enteric fever, viral hepatitis, or any other infection were excluded. The various unusual manifestations of malaria, disease course and outcome were analysed.Results: 58 (27.1%) out of 214 patients studied were found to have atypical manifestations. The unusual features observed were ARDS in vivax malaria (n=11), fulminant hepatic failure (n=5), post malaria neurological syndrome (n=3), stroke (n=3), bilateral optic neuritis (n=1), abducens nerve palsy (n=1), autoimmune haemolytic anemia (n=1), nephrotic syndrome (n=1), splenic infarction (n=2), acute abdomen (n=2), hemiplegia (n=2), psychomotor agitation (n=7), sepsis (n=5), shock (n=3), disseminated intravascular coagulation (n=3) and urticaria (n=2). Six children with vivax presented in deep coma.Conclusions: Clinicians in endemic areas should be aware of unusual and varied presentations of malaria; failure of recognition of which may lead to delayed diagnosis resulting in increased mortality.

Diagnostic and prognostic value of neuron-glial antigen 2 expression in adult acute myeloid leukemia

Background Acute myeloid leukemia (AML) is a hematopoietic stem cell disorder characterized by a block in differentiation of hematopoiesis, resulting in growth of a clonal population of neoplastic cells or blasts. Neuron-glial antigen 2 (NG2) is not expressed by normal hematopoietic stem cells but expressed on blast cells in adult AML. NG2 has been incorporated in diagnostic panels for immunophenotyping of leukemic patients because of its positive predictive value for Mixed Lineage Leukemia (MLL) rearrangements. Aims To assess NG2 expression in adult patients with AML and its correlation with disease-free survival. Patients and methods A total of 60 patients were divided into two groups: 40 newly diagnosed patients with AML and 20 patients diagnosed as having hypersplenism used as a control group. Leukemic patients were diagnosed on the basis of clinical presentation, morphological and cytochemical examination of peripheral blood and bone marrow smears, as well as immunophenotyping criteria for diagnosis of AML. NG2 expression was evaluated in the two groups using flow cytometry. Results No significant differences were found in both age and sex in different patient groups. NG2 expression in the patient group versus control group showed a statistically significant difference. There was no statistically significant difference regarding complete blood count, lactate dehydrogenase, and erythrocyte sedimentation rate, as well as blast percentage in the peripheral blood and in the bone marrow on comparing NG2-positive group and NG2-negative group. There is a significant increase in disease-free survival and overall survival in the negative NG2 expression than in the positive NG2 expression group (P=0.043). Conclusion NG2 expression has a major role in the outcome of patients with AML. NG2 expression analysis can be used as a prognostic marker in newly diagnosed patients with AML. NG2 could be a target for therapy by using anti-NG2 antibody in a subset of patients with AML who do not respond to conventional therapy.